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When both conductive hearing loss and sensorineural hearing loss are present at the same time and at the same ear, it is referred to as mixed hearing loss or ‘combined –type’ hearing loss.
Medication or surgery may be the answer to the conductive portion of the mixed hearing loss, but these interventions cannot treat the sensorineural portion of the hearing loss. If you have any questions about mixed hearing loss or hearing loss in general, please contact our practice to speak with an audiologist. The Best Tips for Traveling with Hearing Loss After hearing stories from our patients of missed connections, alarms, and added stress while traveling, we’ve packed together our best hearing loss travel tips in an easy-to-follow guide.
Ticking 'Remember my selection' will make sure you are returned to this country website again the next time you visit. Just as no two stories of hearing loss are the same, neither are the stories of overcoming it. Designed to help adults with high-frequency hearing loss, our Cochlear™ Nucleus® Hybrid Implant System is a combination of two proven technologies brought together. Designed to help adults and children with severe to profound hearing loss, our Cochlear™ Nucleus® System mimics the natural hearing function of the inner ear. Designed to help people with conductive hearing loss, mixed hearing loss and single-sided deafness, the Cochlear Baha® System utilizes your body’s natural ability to conduct sound.
Log in for the quickest way to learn about your specific sound processor, warranty information, customized upgrades, hearing tools, new product information and so much more! The Cochlear Family is designed to make your life easier, fuller, safer, more joyful, and more connected. Hearing loss is the third most common physical condition in the United States, affecting more than 38 million people. The Cochlear Baha system helps people with mixed or conductive hearing loss as well as single-sided deafness. A Baha implant is a life-changing event to many patients with hearing losses that are not effectively managed with well-fit hearing aids. Pen Bay Healthcare is a not-for-profit family of services which includes Pen Bay Medical Center, a Leapfrog Group 2012 National Top Hospital and the largest community hospital in Midcoast Maine, as well as Pen Bay Physicians & Associates, Kno-Wal-Lin Home Care and Hospice, Quarry Hill Retirement Community and the Knox Center for Long Term Care.
Conventional hearing aids, the most common solution, aim to overcome the degree of conductive or sensorineural hearing loss by amplifying the incoming signal and sending the amplified sound via air conduction through to the cochlea. Cochlear implants are suitable for individuals with a severe or profound hearing loss, where the extent of destruction to the cochlea’s hair cells is so great that hearing aids are unable to provide benefit. Baha provides an optimal amplification choice for those with conductive, mixed, or single-sided sensorineural deafness through the use of direct bone conduction.
Importantly, while there are a number of implantable technologies for hearing loss (eg, middle-ear implants), Baha remains the only technology that the patient can thoroughly evaluate before surgery. Figure 1 gives an indication of the sound a patient with this type of hearing loss is missing. Even without medical indications, the Baha provides significant benefits over conventional hearing aids due to large gain requirements. Baha provides an optimum solution for patients with conductive hearing loss because the treatment avoids difficulties associated with middle-ear pathology and the limitations of hearing aids.
When deciding on treatment options, it is important to remember that the overall amplification required for people with a mixed loss is less with a Baha than that required for a hearing aid.
Conversely, the air conduction hearing aid must address both the conductive and sensorineural elements. Therefore, for patients with air-bone gaps greater than 30 dB, Baha should be evaluated as a potential amplification option due to numerous reports indicating significant benefit when compared to traditional air-conduction amplification. Single-sided sensorineural deafness (SSD™) poses significant communication difficulties for the patient.
For patients with SSD, the Baha is worn on the deaf side, and it transfers the signal directly across the skull via bone conduction, thus eliminating the head shadow effect described above.
For many patients, the sound will seamlessly transfer from one side to the other via bone conduction.
A recent study15 examined the efficacy of Baha Intenso for patients with a mild hearing loss in the hearing ear (Figure 6).
A number of studies have also compared the performance of Baha versus the more traditional solution of Contralateral Routing of Signal (CROS) hearing aids11,13 (ie, one hearing aid with two microphone attachments). Baha provides an additional treatment of choice that complements conventional hearing aids and cochlear implants. Due to the properties of bone conduction, Baha bypasses the conductive element of conductive and mixed hearing losses, resulting in a reduction in the amount of amplification required when compared to traditional air-conduction aids—devices that must overcome the conductive component.
The recent addition of the Baha Intenso, which compensates for up to 55 dBHL of sensorineural hearing loss (current CE indication; expanded indication awaiting approval from FDA), means that a larger population of individuals can benefit from Baha.
In this case, there is likely to be damage to the outer or middle ear as well as to the inner ear or auditory nerve. Typically, the sensorineural hearing loss is already present and the conductive hearing loss develops later and for an unrelated reason.
Many people who suffer from a mixed hearing loss will receive medical treatment for the conductive hearing but will have to use hearing aid to treat the remaining sensorineural component of their hearing loss. AudigyCertified™ expertise is measured by commitment to patient satisfaction, continuing education, and the expert application of current technology. You should visit your Cochlear country website for the most accurate information specific to your location.

In many situations, Cochlear™ can help with one of these treatment options – hybrid hearing, a cochlear implant or a bone conduction implant.
It’s the only FDA-approved hearing solution that restores access to the high-frequency hearing you are missing through cochlear implant technology, while enhancing your low-frequency hearing through acoustic amplification—all in one device. Using a uniquely designed electrode, it bypasses damage to the inner ear and delivers sound directly to your cochlea.
By connecting to the bone behind your ear, the Baha System bypasses the damaged outer or middle ear and sends sound directly to your healthy inner ear, where sound comes to life. In other words if you've had issues with your outer or middle ear the Baha could be a great solution for you. Through these organizations, and with a staff of more than 100 outstanding physicians and more than 1,500 healthcare professionals, we are able to provide the people of Midcoast Maine with a continuum of both routine and specialty patient-centered medical services. Depending on the degree and nature of their hearing loss, one of three treatments may be suitable: conventional air-conduction hearing aids, cochlear and middle-ear implants, and bone-conduction hearing devices, including Baha® (an osseointegrated hearing device). In cochlear implants, sound is picked up and processed by the sound processor and the cochlea is electrically stimulated, thus restoring the sensation of hearing. The Baha consists of three parts, the ossiointegrated implant, the sound processor, and the abutment that connects the two. Through the use of a softband or test rod, the patient is able to evaluate in advance the potential benefits of Baha. This is, in part, because conductive hearing loss is often concomitant with various outer- and middle-ear abnormalities (eg, atresia) or middle-ear pathologies (eg, continuously draining ear) that preclude hearing aid use. Because of the abnormal growth of loudness caused by sensorineural hearing loss, most hearing aid rationales prescribe approximately 50% gain of the degree of hearing loss.
Therefore, one would consider providing 100% compensation for the degree of conductive hearing impairment.
A new device, the Baha Intenso™, compensates for up to 55 dBHL of sensorineural hearing loss (current CE indication; expanded indication awaiting approval from FDA).
Put simply, the device bypasses the conductive element of the hearing loss and addresses the sensorineural component directly. Example of the aided sound-field thresholds following the fitting of a Baha for a patient with mixed hearing loss. While hearing aids are good at compensating for sensorineural hearing loss, compensation for the conductive element rapidly increases the required gain and maximum power output. Approximately 18% of patients with a severe or profound hearing loss have a significant mixed component to their loss. Increase in available gain with Baha Intenso that is available with the implementation of an active feedback cancellation system.
Primarily, this difficulty is due to the inability to accurately localize where sound is coming from. In this way, sounds are efficiently transferred across the skull from the deaf side to the good ear via bone conduction. For a small number of patients, additional amplification force may be required to overcome an increased interaural attenuation to provide sufficient loudness in the good ear. An expanding area of research for Baha is for patients who have a single-sided sensorineural deafness and some degree of hearing loss in the good ear.
Improved aided thresholds in patients with a profound loss in one ear and a mild hearing loss in the contralateral ear. The authors found that the additional amplification provided by the device effectively normalized performance.
These studies reported that speech understanding and subjective reports were significantly better with the Baha than with CROS-based solutions. Osseointegration provides options for patients with conductive, mixed, or single sided sensorineural hearing losses.
Miller, PhD, addressed the topic of sudden hearing loss and single-sided deafness in the special December 2003 edition of HR available in the online archives. Similarly, due to the ease with which bone-conducted sounds transfer across the skull, the device offers a relatively simple solution for people with single-sided sensorineural deafness. Together with the advanced signal processing of Divino and the superpower performance of Cordelle, Intenso complements the portfolio of these devices by offering a discreet yet powerful head-worn solution. Flynn, PhD, is director of research and applications in the Cochlear Bone Anchored Solutions Group of Cochlear Corporation, Gothenburg, Sweden. Long-term results of bone-anchored hearing aid recipients who had previously used air-conduction hearing aids. An intra-individual comparison of the previous conventional hearing aid with the bone-anchored hearing aid: the Nijmegen group questionnaire. Intraindividual comparison of the bone-anchored hearing aid and air-conduction hearing aids.
Bone-anchored hearing aids in unilateral inner ear deafness: an evaluation of audiometric and patient outcome measurements.
Amplification in the rehabilitation of unilateral deafness: speech in noise and directional hearing effects with bone-anchored hearing and contralateral routing of signal amplification. To determine if either is right for you, familiarize yourself with the following information and schedule an appointment with a Hearing Implant Specialist to start the discussion.
Also meet Gary Friedman, who has 33 years experience as an audiologist with an emphasis on hearing rehabilitation.

We encourage you to come to this educational seminar learn about the product and then see if this is something that could benefit you. Although each of these treatments seeks to overcome the difficulties caused by hearing loss, the differences among these approaches provide specific advantages for different populations. This process compensates for the destruction of the hair cells by routing the signal directly to the auditory nerve. The sound processor is connected directly to the skull through an osseointegrated titanium implant in the temporal bone.
With Baha, the conductive element of the hearing loss is bypassed by sending sound vibrations directly from the sound processor, through the skull, and to the cochlea. For example, for a sensorineural hearing loss of 60 dBHL, the hearing aid would prescribe approximately 30 dB of gain.
Counterintuitively, most published prescriptive formulae recommend only 75% compensation for the conductive element.2,3 Interestingly, this decision has been based on the technical limitations of the hearing aid rather than the needs of the patient. Circles represent air-conduction thresholds and arrows represent bone-conduction thresholds. As observed in Figure 5, Intenso produces 10-15 dB more gain for the patient through the use of a more powerful transducer and an active feedback cancellation system. This provides a more efficient and comfortable method of sound transmission to the cochlea.
These requirements indicate that conventional air conduction hearing aids may have insufficient overall power and that saturation from loud inputs will occur more readily. Given the limitations of conventional hearing aids, and the capability of Baha, numerous studies4-9 recommend that, when the conductive component of the mixed hearing loss becomes greater than 30 dB, Baha should be the amplification method of choice. In addition, speech-understanding difficulties arise in situations where the noise is directed toward the good ear and the talker is near the deaf ear.
For these patients with an increased head transfer function, a more powerful device, such as the Intenso, is recommended.
It may be for these patients that the unilateral total hearing loss increases the difficulties experienced from a mild hearing loss, and that a Baha becomes even more relevant.
For all conditions, speech comes from the front and noise comes from the good side (red), deaf side (blue), or front (black). Before bone-anchored devices, the patient was at a significant disadvantage when speech was spoken from the deaf side.
Therefore, for patients with single-sided deafness, the bone-anchored device should be considered the treatment of choice.
While there are a number of implantable technologies available (eg, middle-ear implants), Baha remains the only one that the patient can thoroughly evaluate, via softband or test rod, before surgery.
As with sensorineural and conductive hearing losses, only a thorough diagnostic hearing and medical evaluation can identify a specific cause. At Pen Bay Ear, Nose, and Throat we are pleased to offer the Baha hearing implant system which is designed for people with single sided deafness and for people with conductive hearing loss from either disease or prior surgery.
Sound vibrations are thereby passed through the titanium implant and vibrate the temporal bone that houses the cochlea, thereby providing the sensation of hearing. A number of technical limitations arise when attempting to fit hearing aids to larger conductive loss.
To achieve this, an additional amplification force is required to compensate for the degree of sensorineural deafness. For patients in these studies, Baha performed significantly better than conventional air-conduction hearing aids in terms of aided thresholds, speech perception measurements, and subjective reports. In many situations (eg, driving a car), the patient is unable to compensate for this difficulty by changing head position.
For this population, the Baha improves performance so that the patient experiences a more natural overall sound picture.
Or, perhaps, it’s been a part of your life for so long that you can’t remember how it started. Bone conduction thereby overcomes conductive hearing loss by innervating the cochlea directly.
These include insufficient gain, saturation, feedback, and also the necessity of a tight-fitting earmold. As shown in Figure 4, the resultant aided free-field thresholds are extremely good with the device, providing excellent compensation for the sensorineural element of the mixed hearing loss. It can also compensate for a degree of sensorineural hearing loss in a mixed hearing loss with increased amplification. The insufficient power of most hearing aids compromises the hearing performance of the patient with conductive hearing loss. Additionally, Baha provides a solution for individuals with single-sided sensorineural deafness, as the skull can efficiently conduct the sound from one side of the head to the opposite cochlea.

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